Swimmer’s Ear

Otitis externa or Swimmer’s Ear:

Infection of the walls of the external auditory canal is quite common and usually called swimmer’s ears. However, in most patients the infection is not caused by swimming rather by manipulation of the ear canal with fingernails or other foreign objects. The most appropriate treatment of an uncomplicated bacterial otitis externa is topical eardrops. Antibiotics by mouth are usually not indicated in healthy people for uncomplicated otitis externa and could cause unnecessary side effects. At times a wick (spong) is placed in the infected ear canal to prevent it from collapsing and allow for better penetration of the antibiotic ear drops into the ear. The reason some infections of the ear canal do not respond to antibiotic ear drops could be resistant organism, immune compromised status of the patient (diabetes, HIV, etc.), and presence of foreign body or infected cerumen that needs to be debrided. Also very commonly the infection could be due to a fungus which does not respond but actually grows more aggressively in presence of antibiotic ear drops.

Fungal external ear infections, known as fungal otitis externa or otomycosis, happen commonly in humid environment or after treatment of a bacterial ear infection with oral antibiotics. In many cases of otitis externa, patient initially improves with oral antibiotics but then develops worsening of symptoms. This is classic for a fungal otitis externa which is usually treated with debridement, dry ear precautions, and topical antifungal medication. Oral antifungal are rarely indicated for these infections. In patients with poor immune system, fungal infections could become invasive and require much more aggressive treatment.